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Year 3 MedEd > Vascular > Flashcards

Vascular Flashcards

Vascular dx

1
Q

What is the definition of an abdominal aortic aneurysm?

A

A dilation of the abdominal aorta to >1.5x its normal diameter, or >3cm

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2
Q

What are the two types of aneurysms?

A

Saccular

Fusiform

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3
Q

What are three causes of abdominal aneursyms?

A

Atheroma
Trauma
CTD (Marfans, ED)

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4
Q

What are the presenting symptoms of AAAs?

A

Majority are asymptomatic

Can complain of pain/pulsation in the back

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5
Q

What are the risk factors for AAAs?

A 
Male
CTD
Hypertension
Hypercholesterolaemia
Smoking
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6
Q

What is the mortality rate of ruptured AAAs?

A

90%

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7
Q

What is the presentation of a ruptured AAA?

A

Severe abdominal pain, radiating to the back

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8
Q

What can be found on examining a Pt with AAA?

A

Retroperitoneal bleeding -> Grey Turner’s/Cullen’s

Hypovolaemic shock -> low BP/high HR

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9
Q

What is the screening criteria for AAAs?

A

Males >65yrs

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10
Q

What is the modality of investigation for AAAs?

A

Ultrasound scan

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11
Q

What is the management plan for small AAAs (3.5-4.4cm)?

A 
Follow up scan in 1 year
Conservative management
-smoking, exercise, weight loss
Medical management
-statins, aspirin, BP management
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12
Q

What is the management plan for medium AAAs (4.5-5.4cm)?

A 
Follow up scan in 3 months
Conservative management
-smoking, exercise, weight loss
Medical management
-statins, aspirin, BP management
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13
Q

What is the management plan for large AAAs (5.5cm+)?

A

Open aortic surgery

Endovascular repair

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14
Q

What are the cons of open aortic surgery?

A

Longer recovery time hence done on young patients

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15
Q

What are the cons of endovascular repair?

A

Less peri-op mortality but greater risk of needing more procedures

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16
Q

What is the definition of an aortic dissection?

A

A tear in the tunica intima causing blood accumulation between the inner and outer tunica media.

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17
Q

What is the Stanford Classification of aortic dissections?

A

Type A- ascending aorta tear

Type B- descending aorta tear (after the left subclavian)

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18
Q

What are the risk factors of an aortic dissection?

A 
HTN
Atherosclerosis
CTD
Iatrogenic (angiography/plasty)
Congenital- coarctation
Cocaine
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19
Q

What are the presenting symptoms of aortic dissections?

A

Sudden central tearing pain in the back

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20
Q

What can happen if the tear affects the carotids?

A

Hemiparesis

Blackouts

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21
Q

What can happen if the tear affects the coronary arteries?

A

Angina

MI

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22
Q

What can happen if the tear affects the renal arteries?

A

AKI

Renal failure

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23
Q

What can happen if the tear affects the coeliac trunk?

A

Abdominal pain

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24
Q

What can you find on examination of a Pt with aortic dissection?

A 
Tachycardia
BP difference of >20mmHg in upper limbs
Radio-radial delay
Wide pulse pressure
Murmur below scapulae
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25
Q

What are the two key signs of aortic insufficiency?

A

Collapsing pulse
Early diastolic murmur
(Aortic regurgitation)

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26
Q

What bloods investigations would you do for aortic dissection and why?

A

FBC, U&Es- renal damage
Xmatch- 10 units of blood for hypotension
Cardiac enzymes- heart attack

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27
Q

What would you see in a CXR of a Pt with aortic dissection?

A

Widened mediastinum

Visible aortic notch

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28
Q

Why would you do a CT angiography of a Pt with aortic dissection?

A

Visualise the location of the dissection

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29
Q

Which is the best diagnostic intervention for aortic dissection?

A

CT angio

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30
Q

A 69 year old man with a background of hypertension complained of flank pain all day at work. He then has sudden onset abdominal pain that radiates to his back and groin. He arrives in an ambulance unconscious. The doctor notes Grey Turner’s and Cullen’s signs. What is the most likely diagnosis?

A. Renal colic
B. Myocardial ischaemia
C. Ruptured AAA
D. Pancreatitis

A

C. Ruptured AAA

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31
Q

A 65 year old gentleman is coming in for screening for a AAA following a letter received in the post. What modality would be used as a screening tool?

A. Abdominal ultrasound
B. Abdominal CT
C. Abdominal X-ray
D. Doppler ultrasound

A

A. Abdominal Ultrasound

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32
Q

A 65 year old gentleman with a known AAA (last measured 5.2 cm) comes in complaining of severe abdominal pain. What investigation would you use to assess if it has ruptured?

A. Abdominal ultrasound
B. Abdominal CT
C. Abdominal X-ray
D. Doppler ultrasound

A

B. Abdominal CT

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33
Q

A 70 year old gentleman with known hypertension presents to A&E with tearing chest pain, radiating to the back. His CXR shows a widened mediastinum. What is the most likely diagnosis?

A. Aortic dissection
B. STEMI
C. Tietze’s syndrome
D. Costochondritis

A

A. Aortic dissection

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34
Q

Which of the following examination findings is not consistent with an aortic dissection?

A. BP 100/40
B. Ejection systolic murmur
C. Collapsing pulse
D. Radio-radio delay

A

B. Ejection systolic murmur

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35
Q

What is intermittent claudication?

A

Cramping muscular pain in the calf, thigh, or buttocks, precipitated by exercise and alleviated by rest

36
Q

What are the risk factors for intermittent claudication?

A

Smoking
Diabetes mellitus
Hypertension
Cholesterol

37
Q

What are the signs of intermittent claudication?

A 
Weak peripheral pulses
Punched out ulcers
Hair loss
Cyanosis
Brittle toes
Beurger's angle <20
38
Q

What is Leriche’s syndrome?

A

Narrowing of the abdominal aorta as it bifurcates into the common iliacs

39
Q

What is the triad seen in Leriche’s syndrome?

A

Bilateral claudication
Erectile dysfunction
Weak femoral pulses

40
Q

What is the triad of critical limb ischaemia?

A

Rest pain (Alleviated by standing)
Arterial ulcers
Gangrene

41
Q

What is the prognosis for intermittent claudication?

A

80% chance of improvement
5% intervention
1% amputation
15% dead in 5 years

42
Q

What is the prognosis for critical limb ischaemia?

A

90% intervention
25% amputation
50% dead in 5 years

43
Q

What are the different indices (levels) of ABPI?

A

> 0.95- normal
0.5-0.95-claudication
0.3-0.5- rest pain
<0.3- critical ischaemia

44
Q

What can cause false negatives in ABPIs?

A

Calcification of vessels

45
Q

What other investigations can be done for claudication?

A

Doppler USS

Magnetic resonance angiography

46
Q

What is acute limb ischaemia?

A

Sudden lack of blood flow to a limb

47
Q

What are the two causes of acute limb ischaemia?

A

Thrombus- due to peripheral arterial disease

Embolus- from the heart

48
Q

What are the six P’s of acute limb ischaemia?

A 
Pain
Pallor
Pulselessness
Perishingly cold
Paraesthesia
Paralysis
49
Q

What is the classification of acute limb ischaemia?

A

Viable
-no neuro signs + audible Doppler
Threatened
-sensory loss + tense calf + no audible Doppler
Dead
-complete neurological deficit, fixed mottling

50
Q

A 65 year old lady with known CVD presents to the GP with pain in her legs. She finds the pain comes on when she is walking to the shops, but is relieved by rest. She has a 40 pack year smoking history. What is the most likely diagnosis?

A. Acute limb ischaemia
B. Deep vein thrombosis
C. Varicose veins
D. Peripheral arterial disease

A

D. Peripheral arterial disease

51
Q

A 60 year old male with known atrial fibrillation presents to A&E with a sudden onset of a painful, cold leg. The doctor is unable to feel peripheral pulses, and upon examination notes a loss of sensation and paralysis. A venous Doppler is inaudible. What is the definitive management?

A. Embolectomy
B. Watch and wait
C. Angioplasty
D. Amputation

A

D. Amputation

52
Q

A 69 year old heavy smoker complains of pain in his leg when he walks to the bus stop. On examination of his leg, you see shiny skin, patchy hair, weak pulses and brittle toenails. What would be the first line investigation?

A. Angiography
B. Doppler ultrasound
C. Magnetic resonance angiography
D. ABPI

A

D. ABPI

53
Q

What is a DVT?

A

Formation of a clot in the deep veins

54
Q

What is Virchow’s triad?

A

Venous stasis
Endothelial damage
Hypercoagulability

55
Q

What are the inherited risk factors for DVTs?

A

Antithrombin deficiency
Protein C/S deficiency
Antiphospholipid syndrome

56
Q

What are the acquired risk factors for DVTs?

A 
Age
Pregnancy
Trauma
Surgery
Immobility
Previous DVT
Cancer
Oestrogen
57
Q

What is the presentation of a DVT?

A

50% asymptomatic
Leg swelling
Calf tenderness
Erythema

58
Q

What is found on examination of a DVT?

A

Pitting oedema
Calf warmth
Calf swelling >3cm difference
Prominent superficial veins

59
Q

What is the scoring used for DVTs?

A

Well’s score

60
Q

If the Well’s score is >=2 what investigation do you do?

A

Leg vein USS

61
Q

If the Well’s score is >=2 and the USS is -ve what investigation do you do, and what would you do if THAT finding was positive?

A

D-dimer

If D-dimer is positive, repeat USS in 6-8 days

62
Q

If the Well’s score is <2 what investigation do you do, and what would you do if THAT finding was positive?

A

D-dimer

If D-dimer is positive, perform USS

63
Q

What management would you provide for a Pt with a DVT?

A

LMWH for 5 days

Warfarin within 24h for at least 3 months

64
Q

When would you consider thrombolytic therapy?

A

If the symptoms have been less than two weeks, the Pt is well, has a good life expectancy and at a low risk of bleeding

65
Q

What surgical procedure can be offered for a DVT?

A

Thrombectomy

66
Q

What preventative management can be offered for a DVT?

A

Stop OCP 4 weeks before surgery
Compression stockings
LMWH for high risk Pts

67
Q

Why is LMWH given with warfarin?

A

Warfarin inhibits F2,7,9,10, Protein C and S
Hence it has an initial pro-coagulative phase
LMWH is given to counteract this

68
Q

A 38 year old lady presents with swelling in her leg, and associated calf tenderness. She has been taking the OCP for several years. What is the best management for this patient?

A. Warfarin + LMWH
B. Warfarin
C. Aspirin
D. LMWH + Aspirin
E. LMWH
A

A. Warfarin + LMWH

69
Q

A 72 year old gentleman is complaining of pain in his right leg. He is 8 days post operative for a tibia/fibula fracture repair. What is the minimum amount of time the patient must be anticoagulated for?

A. 3 months
B. 6 months
C. 1 year
D. Lifelong

A

A. 3 months

70
Q

A 32 year old woman on the OCP complains of pain in her calf for one day. She does not have any chest pain or shortness of breath. The nurse tells you that the A&E doctors assessed the patient, who scored 2 although she cannot remember the name of the score. What is the most appropriate initial investigation?

A. D-Dimer
B. MRA
C. Leg Vein USS
D. ABPI

A

C. Leg Vein USS

71
Q

What is the cause of an arterial/ischaemic ulcer?

A

Lack of blood flow causing ischaemia, commonly due to PAD

72
Q

What are the characteristics of an arterial/ischaemic ulcer?

A 
Between toes/lateral aspect of foot and ankle
Punched out appearance
Very painful
Gangrene/necrosis
Minimal exudate
Surrounding skin- hairless, cold, shiny
73
Q

What is the cause of a venous ulcer?

A

Inadequate valvular function causes leakage of blood and protein into extravascular spaces.
Build up of fibrinogen and fibrin causes reduced O2 delivery
Leukocyte accumulation releases proteolytic enzymes and ROS

74
Q

What are the characteristics of a venous ulcer?

A 
Located in the "gaiter" region
Shallow, irregular
Usually painless
Wet
Surrounding skin- oedematous, lipodermatosclerosis, haemosiderin deposition
75
Q

What is the cause of a neuropathic ulcer?

A

Diabetics with peripheral neuropathy

Loss of pain sensation in blisters/pressure injuries

76
Q

What are the characteristics of a neuropathic ulcer?

A 
Ulcers on the plantar aspect
Even wound margins
Loss of pain sensation
Deep ulcer
Calloused skin
May be infected
Palpable pulses and warm foot
77
Q

A 75 year old woman with long standing hypertension has had progressive swelling of her legs over the last 3 months. She has consulted her GP because she has developed an ulcer on the anterior aspect of the right shin which weeps serous fluid profusely. What is the cause of the ulcer?

A. Arterial
B. Venous
C. Neuropathic
D. Rheumatoid Arthritis

A

B. Venous

78
Q

A 62 year old diabetic woman shows you an ulcer on the bottom of her foot. It has a little stone lodged in it, which she hasn’t noticed. On neurological examination, she has no peripheral sensation of light touch up to her mid-foot. What is the cause of the ulcer?

A. Arterial
B. Venous
C. Neuropathic
D. Trauma

A

C. Neuropathic

79
Q

A 78 year old obese woman presents with an ulcer on the top of her foot and one between her toes. They haven’t healed in two months. They are quite small, look punched out and yellow. She complains her feet are always cold and has a history of coronary artery disease.

A. Arterial
B. Venous
C. Neuropathic
D. Trauma

A

A. Arterial

80
Q

A 45 year old lady presents with a 4 cm chronic ulcer on the medial aspect of the lower leg. She has a history of pain in the calf on walking. The skin around the ulcer is brown and heavily indurated.

A. Arterial
B. Venous
C. Neuropathic
D. Trauma

A

B. Venous

81
Q

What is the cause of varicose veins?

A

Valvular insufficiency

82
Q

What are the risk factors of varicose veins?

A

Obesity
Pregnancy
OCP
Family history

83
Q

What are the presentations of varicose veins?

A 
Pain
Unsightly legs
Cramps
Tingling
Restless leg
84
Q

What are the examination findings of varicose veins?

A 
Oedema
Eczema
Ulcers
Phlebitis
Atrophie blanche
Lipodermatosclerosis
85
Q

What is the management of varicose veins?

A

Endothermal ablation
US-guided foam scleropathy
Surgery

Year 3 MedEd (29 decks)

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